Insulin requirement is highly dynamic, causing unpredictable reductions in insulin needs. Therefore, frequent dosage titration is needed to achieve and maintain therapy goals. Hypoglycemia is the primary risk in insulin management. We sought to determine if reductions in insulin requirements are associated with hypoglycemia frequency, by using data from a technology-based insulin titration service. To keep glycemia stable, the service adjusts insulin dosage at least weekly. Therefore, insulin dosage reacts quickly to both hyper- and hypo- glycemia, and as a result closely tracks insulin requirement. Outcome was defined as events of considerable and persistent decrease in insulin requirements as identified by reductions in daily dose ≥25%. Patients (N=246) were followed for 2.8±0.9 years. Insulin titrations occurred every 6.4±1.9 days. Considerable decrease in insulin requirement was experienced by 70.3% of the patients, every 15.0±7.5 months, lasted 10.0±7.7 weeks, and insulin requirements declined by 39.9%±12.6%. Hypoglycemia (<54mg/dl) occurred 6.0±7.2 times per year, and was 6.5 times more prevalent during reductions in insulin needs (Figure). In total, 39.9% of hypoglycemic events occurred during the 10.5% of time when insulin requirements declined. Substantial reduction in insulin needs explains a significant part of the hypoglycemic burden, which demands frequent titration to preserve treatment safety.
S.G. Bisgaier: Employee; Self; Hygieia. D.J. Isaman: Consultant; Self; Hygieia. E. Bashan: Employee; Self; Hygieia. I. Hodish: Stock/Shareholder; Self; Hygieia.
